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Objectives: Patients with body dysmorphic disorder (BDD) have difficulty in recognising facial emotions, and there is evidence to suggest that there is a specific deficit in identifying negative facial emotions, such as sadness and anger. Methods: This study investigated facial emotion recognition in 19 individuals with BDD compared with 21 healthy control participants who completed a facial emotion recognition task, in which they were asked to identify emotional expressions portrayed in neutral, happy, sad, fearful, or angry faces. Results: Compared to the healthy control participants, the BDD patients were generally less accurate in identifying all facial emotions but showed specific deficits for negative emotions. The BDD group made significantly more errors when identifying neutral, angry, and sad faces than healthy controls; and were significantly slower at identifying neutral, angry, and happy faces. Conclusions: These findings add to previous face-processing literature in BDD, suggesting deficits in identifying negative facial emotions. There are treatment implications as future interventions would do well to target such deficits.
Objectives: Recognition of cognitive impairment in chronic kidney disease (CKD) and its impact on functioning in adults is growing. The vast majority of studies to date have been conducted in older populations where CKD is more pronounced; however, the degree to which age-related cognitive changes could be influencing these findings remains unaddressed. This current study thus aimed to review cognitive impairment findings by stage in non-elderly CKD samples. Methods: PubMed and Medline via Scopus were searched for cross-sectional or cohort studies and randomized controlled trials that assessed cognitive function in individuals with CKD in any research setting. CKD studies including patients at any illness stage were included providing participants were below 65 years old, were not on peritoneal dialysis and had not undergone a kidney transplant. Results: Fifteen studies, with a total of 9304 participants, were included. Cognitive function broadly deteriorated from stage 1 to stage 5. Early stage CKD was associated with a drop in speed of processing, attention, response speed, and short-term memory abilities. Moderate stage CKD was associated with deficits in executive functioning, verbal fluency, logical memory, orientation and concentration. People with end stage kidney disease manifested significant deficits in all previous cognitive domains, along with cognitive control, delayed and immediate memory, visuospatial impairment, and overall cognitive impairment. Conclusions: Cognitive impairment is evident across the stages of CKD, independent of age-related changes, for both lower-order and higher-order cognitive abilities. These impairments also increase between the stages, suggesting a cumulative effect. Future directions for research are discussed. (JINS, 2019, 25, 101–114)
Major depressive disorder is a common diagnosis associated with a high burden of disease that has proven to be highly heterogeneous and unreliable. Treatments currently available demonstrate limited efficacy and effectiveness. New drug development is urgently required but is likely to be hindered by diagnostic limitations.
Sandeep Ranote, Consultant Child and Adolescent Psychiatrist,
Andrea Phillipou, Postdoctoral Research Fellow at St Vincent's Hospital, Melbourne,
Susan Rossell, Director of the Centre for Mental Health and a Professor of Cognitive Neuropsychology at Swinburne University,
David Castle, Psychiatry at St Vincent's Health Australia and the University of Melbourne
‘Who wants to recover? It took me years to get that tiny. I wasn't sick; I was strong.’
– Laurie Halse Anderson (2011)
Looking back, I didn't think I was ill at the start. I felt in control and I felt good because I was thin, which made me feel strong and successful. Aren't all successful women thin and beautiful?
That was when I was 15 years old; at 19, I know that none of that is true. I did have an illness, a real illness that hit me in secondary school, preparing for important exams while also breaking up with my first boyfriend.
I thought I wasn't beautiful enough for him and the breakup meant that I also lost my peer group at the time. I felt alone, under pressure and hated myself. I started to diet, like most people do, and joined the gym. I started getting results, which for me was important, in the same way exams were. I lost weight and saw this as positive, so I began to do more exercise, eat less and stopped eating sugary and fatty foods. I didn't see my headaches and dizziness as a problem, I just thought I needed to sleep more. But eventually I wasn't sleeping and my grades began to drop. I felt tired and low and remember sometimes having thoughts that I no longer wanted to live.
I didn't understand why my parents were anxious and arguing with each other about me. They could see something was wrong but I couldn't see it; they tried to talk to me but I couldn't hear them. When I fainted, I was taken to hospital, and this was when I accepted and started treatment with a specialist eating disorder team, who became almost part of our family. They gave not only me much needed support but also the whole family.
My message to you all is that there is hope and you can get help. Don't delay, share your concerns, get the treatment and don't let this illness steal your life.
Self-starvation in women is not a modern phenomenon. Medieval women in the 13th century believed it would lead to sainthood, sometimes referred to as ‘anorexia mirabilis’.
Objectives: Existing models of trichotillomania (TTM; hair pulling disorder) rely heavily on a biological predisposition or biological pathogenesis of the disorder, but fail to capture the specific neuropsychological mechanisms involved. The present systematic review aims to scope existing neuropsychological studies of TTM to explore gaps in current models. Methods: A systematic literature search was conducted to detect all published primary studies using neuropsychological and neuroimaging measures in a cohort of individuals experiencing TTM. Studies addressing neuropsychological function were divided into domains. Findings from imaging studies were considered within brain regions and across methodology. Results: Thirty studies with a combined 591 participants with TTM, 372 healthy controls and 225 participants in other types of control group were included. Sixteen studies investigated neuropsychological parameters, and 14 studies pursued neuroimaging technologies. Available studies that used neuropsychological assessments and reported a statistically significant difference between those with TTM and controls ranged in effect size from 0.25 to 1.58. All domains except verbal ability and visual ability reported a deficit. In neuroimaging studies, several structural and functional brain changes were reported that might be of significance to TTM. Only tentative conclusions can be made due to the use of multiple methodologies across studies, a major limitation to meaningful interpretations. Conclusions: Positive neuropsychological and neuroimaging results require replication, preferably with multi-site studies using standardized methodology. Increased standardized testing and analyses across the literature, as a whole, would improve the utility and interpretability of knowledge in this field. (JINS, 2018, 24, 188–205)
Objectives: Body dysmorphic disorder (BDD) is characterized by repetitive behaviors and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance. There are some similarities, but also important differences, between BDD and obsessive-compulsive disorder (OCD), not just in terms of core clinical symptoms, but possibly in the domain of perception. This study compared the nature and extent of perceptual anomalies in BDD versus OCD and health controls (HC), using a modified Mooney task. Methods: We included 21 BDD, 19 OCD, and 21 HC participants, who were age-, sex-, and IQ-matched. A set of 40 Mooney faces and 40 Mooney objects arranged in three configurations (i.e., upright, inverted, or scrambled) were presented under brief (i.e., 500 ms) free-viewing conditions. Participants were asked to decide whether each image represented a human face, an object, or neither in a forced-choice paradigm. Results: The BDD group showed significantly reduced face and object inversion effects relative to the other two groups. This was accounted for by BDD participants being significantly more accurate in identifying inverted Mooney faces and objects than the other participants. Conclusions: These data were interpreted as reflecting an overreliance on independent components at the expense of holistic (configural) processing in BDD. (JINS, 2017, 23, 471–480)
Depression is among the most prevalent of mental disorders and is one the leading causes of disability worldwide (World Health Organization, 1996). A study across six countries found that patients with higher scores for depressive symptoms had worse health, functional status, quality of life and greater use of health services across all sites (Herrman et al, 2002). This chapter provides an overview of the issues and methods involved in the assessment of depressive symptoms in adults and older persons; different factors and methods are required for younger consumers.
Why assess outcomes?
Given its often erratic and relapsing course, the assessment of the quality and severity of depression is important for a number of reasons. These have been divided by Hickie et al (2002) into two groups: clinical and evaluative. The clinical reasons comprise: enhancing the involvement of consumers in their own treatment; documenting a range of clinically relevant aspects of life; improving the identification of early relapse; comparing responses to different treatments; improving understanding of short- and long-term outcomes; and alerting the clinician to a possible need to change the treatment or management. Their list of non-clinical purposes include: evaluating new treatments; contributing to assessment of cost-effectiveness; understanding variations in quality and access to services; and evaluating the impact of major health service innovations and specific policy initiatives. This is an impressive list of reasons for measuring outcomes in depression, to which we add a few of our own. Depression, like most mental disorders, has an effect beyond the index consumer. In addition to the mental pain of the condition itself, there is often ‘collateral damage’ to family members in terms of worry, burden of care and impaired child care, as well as to society at large in terms of lost productivity and treatment costs. Certain forms of outcome measure can target some of these effects. Also, it is known that not all aspects of the depressed state recover at the same rate (see below). By formally assessing domains beyond primary symptoms, one can assess wider aspects of recovery, such as social and occupational functioning.
Objectives: Emotion recognition impairments have been demonstrated in schizophrenia (Sz), but are less consistent and lesser in magnitude in bipolar disorder (BD). This may be related to the extent to which different face processing strategies are engaged during emotion recognition in each of these disorders. We recently showed that Sz patients had impairments in the use of both featural and configural face processing strategies, whereas BD patients were impaired only in the use of the latter. Here we examine the influence that these impairments have on facial emotion recognition in these cohorts. Methods: Twenty-eight individuals with Sz, 28 individuals with BD, and 28 healthy controls completed a facial emotion labeling task with two conditions designed to separate the use of featural and configural face processing strategies; part-based and whole-face emotion recognition. Results: Sz patients performed worse than controls on both conditions, and worse than BD patients on the whole-face condition. BD patients performed worse than controls on the whole-face condition only. Conclusions: Configural processing deficits appear to influence the recognition of facial emotions in BD, whereas both configural and featural processing abnormalities impair emotion recognition in Sz. This may explain discrepancies in the profiles of emotion recognition between the disorders. (JINS, 2017, 23, 287–291)
The efficacy of acceptance and commitment therapy (ACT) in psychosis has been reported but not for medication-resistant psychosis.
To test the efficacy of ACT in a sample of community-residing patients with persisting psychotic symptoms. (Australian New Zealand Clinical Trials Registry: ACTRN12608000210370.)
The primary outcome was overall mental state at post-therapy (Positive and Negative Syndrome Scale –total); secondary outcomes were psychotic symptom dimensions and functioning. In total, 96 patients were randomised to ACT (n = 49) or befriending (n = 47). Symptom, functioning and process measures were administered at baseline, post-therapy and 6 months later.
There was no group difference on overall mental state. In secondary analyses the ACT group showed greater improvement in positive symptoms and hallucination distress at follow-up: Cohen's d = 0.52 (95% CI 0.07–0.98) and 0.65 (95% CI 0.24–1.06), respectively.
Improvements reflected the treatment focus on positive symptoms; however, absence of process-measure changes suggests that the ACT intervention used did not manipulate targeted processes beyond befriending. Symptom-specific therapy refinements, improved investigation of process and attention to cognitive functioning and dose are warranted in future research.
Objectives: Use of appropriate face processing strategies is important for facial emotion recognition, which is known to be impaired in schizophrenia (SZ) and bipolar disorder (BD). There is preliminary evidence of abnormalities in the use of face processing strategies in the former, but there has been no explicit attempt to assess face processing in patients with BD. Methods: Twenty-eight BD I, 28 SZ, and 28 healthy control participants completed tasks assessing featural and configural face processing. The facial inversion effect was used as a proxy of second order configural face processing and compared to featural face processing performance (which is known to be relatively less affected by facial inversion). Results: Controls demonstrated the usual second-order inversion pattern. In the BD group, the absence of a second-order configural inversion effect in the presence of a disproportionate bias toward a featural inversion effect was evident. Despite reduced accuracy performance in the SZ group compared to controls, this group unexpectedly showed a normal second-order configural accuracy inversion pattern. This was in the context of a reverse inversion effect for response latency, suggesting a speed-versus-accuracy trade-off. Conclusions: To our knowledge, this is the first study to explicitly examine and contrast face processing in BD and SZ. Our findings indicate a generalized impairment on face processing tasks in SZ, and the presence of a second-order configural face processing impairment in BD. It is possible that these face processing impairments represent a catalyst for the facial emotion recognition deficits that are commonly reported in the literature. (JINS, 2016, 22, 652–661)